20040996.pdfI
DATE RECEIVED
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PERMIT EXPIRES _S�
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CITY OF EDMONDS
USE' PERMIT
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ADDRESS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OFLUSINESS
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
HW Permit Required 13
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Street use Permit Roq'd
inspection Required
Sidewalk Required
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REQUIRED DEDICATION- FT
Underground 13
wiring required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
NAME
YES 13 NO 13
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REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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REQUIRED SETBACKS (Fr.)
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ALLOWED PROPOSED
FRONT SIDE REAR
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ADDITION E] COMMERCIAL OMPLIANC E OR
CHANGE OF USE
PARKING
REO'D PROVIDED
LOT AREA
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GRADING FENCE
REPAIR 13 CYDS ( X FT)
REMARKS
DEMOLISH 1:1 TANK Ei OTHER
Ei GARAGE RETAINING WALL FIRE SPRNKLER
1:1 ALARM
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REMARKS
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ-101
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VALUATION
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Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge
HECK NO: VESTED DATE Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
LU PERMIT APPLICATION: ISO DAYS
0. PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
(111 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
M EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND Fire Inspection Receipt
M ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapelnsp. Total Amt. Due
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' ---TReceipt # 13�D
Recording Fee
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- 'CALL This application is not a permit until signed by the
TION; AND IN DOING TIiE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building 011icial or hisillef Deputy. and Fees ate paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided
WORKMEN'S COMPENSA���RANCE AND RCW 18 27.
OFFICIALS IGN E ATEi
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IGNED
IGNATURE (OWNER 0 AGEN DATE SIGN (425)
1/ / IA?1421
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t'-,k A 1-0220 DATE
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RFLEASED
-ATTENTIOA EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- 0131GINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR
04102 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING..........................
FRAMING........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
The Initials MT are Milton
Thollipson, a temporary contract
ilispectol* for tile City.
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